Roles and notes of high-dose blood purification therapy for acute liver failure with encephalopathy

Abstract

Liver transplantation is the only evidence-established treatment for acute liver failure with hepatic encephalopathy and is the first-choice treatment in Europe and the United States. In Japan, owing to a chronic shortage of deceased donors, most patients are first treated medically with a view to living donor liver transplantation. The main component of medical treatment is artificial liver support (ALS), which efficiently awakens patients from hepatic encephalopathy, and blood purification therapy is administered to maintain liver function. Plasma exchange and continuous hemodiafiltration have been traditionally used for ALS. However, hemodiafiltration using a highly permeable hemofilter to increase blood filtration rate may result in a higher rate of encephalitic arousal. This article reviews the conditions, efficacy, and adverse events of high-volume hemodiafiltration, especially online hemodiafiltration.